Finally springing into action, the provincial government has ordered increasing the amount of chlorine added to the city’s water supply in the wake of the three deaths last month from the deadly brain-eating amoeba, Naegleria fowleri.

“The three people who died in September had not been to a swimming pool. It is a serious cause for concern that people are contracting the infection by using tap water,” Health Minister Dr Sagheer Ahmed said at a press conference on Monday.

“The Karachi Water and Sewerage Board has been directed to increase the chlorine level in the water supply by five parts per million.”The deadly amoeba causes primary amoebic meningoencephalitis (PAM), a disease characterised by the inflammation of the brain. The disease has claimed 10 lives in the city during the last six month including that of two children. The amoeba is found in freshwater bodies and can enter the brain through the nasal cavity. It is extremely hard to detect or isolate through normal laboratory procedures.

“The amoeba enters the brain through the nasal cavity so the citizens should use boiled or chlorinated water for washing the nose, particularly while performing ablution,” the minister said. He was accompanied by the newly-appointed commissioner of the city, Hashim Raza Zaidi, KWSB Managing Director Misbahuddin Farid and health department officials.

Ahmed also advised citizens to use chlorine to disinfect their water tanks and have them cleaned twice a month. “The mortality rate for PAM is 98 percent. The amoeba’s detection is only possible through a microscopic examination of the cerebrospinal fluid (CSF) after the infection.”

Ahmed said all private hospitals had been directed to conduct CSF tests on suspected PAM patients.

Awareness campaign

The minister said a public awareness campaign would be launched in the province similar to the one initiated for dengue fever. “Pamphlets will be distributed among people to inform them about the precautionary measures.” He also noted with concern that the water being supplied to Hyderabad and other cities of the province had lower levels of chlorine and ordered that the problem be rectified.

Other sources?

Speaking on the occasion, the KWSB MD said it would be unjustified to blame water for the PAM deaths as there could be “other sources” through which the infection could be contracted.

“The KWSB has asked the Aga Khan University Hospital (AKUH) and Pakistan Council of Scientific and Industrial Research (PCSIR) to analyse the water samples taken from different parts of the city and report whether or not the amoeba is present in the water supplied by the water board.”

Farid said on the health minister’s directives, the KWSB had increased the chlorine in the water supply by 5ppm and the board’s experts were checking its level after every three hours.

Water samples

In a press release, the KWSB spokesperson said water samples were being collected from all over the city and examined on a daily basis. “The KWSB has also approached the PCSIR, the AKUH, the University of Karachi and the NED University to ensure better results.”

The spokesperson said the head of the bacteriology department at the PCSIR and the AKUH laboratory have informed the KWSB that it was almost impossible to detect the amoeba in water and CSF tests were needed for that purpose. They also told the KWSB that to determine as to how the virus functioned and find a cure, a special board could be formed on the water board’s request.

l Use earplugs, swim goggles, or masks if you tend to get ear or eye infections

l Wash open skin cuts and scrapes with clean water and soap

l Use water that has been previously boiled for 1 minute and left to cool; filtered using a filter with an absolute pore size of 1 micron or smaller or purchased with a label specifying that it contains distilled or sterile water

l Use boiled water for cleaning the nose, particularly while performing ablution